Non-Invasive Manual Reduction for Incarcerated Obturator Hernia-Report of Five Cases-

Tanaka, Naoki; Kikuchi, Jun; Yusa, Toru; Ando, Toshinori; Saito, Yuko

doi:10.3919/jjsa.70.1572

Cited by 10 publications

(6 citation statements)

References 8 publications

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“…Recently, elective surgery after spontaneous reduction or noninvasive reduction has been reported to be useful [1][2][3][4] . Rørbaek 5) reported that morbidity and mortality rates were high for patients 80 years of age or older who underwent emergent surgery for groin hernias including obturator hernias and that elective surgery should be performed whenever possible.…”

Section: Discussionmentioning

confidence: 99%

“…Although there was only one death among those patients, the number of patients with complications (29 of 33 patients) was large, and it was considered that elective surgery should be performed whenever possible. Various methods for noninvasive reduction including a method for reduction by flexure, external rotation and adduction of the diseased leg 6) and a method of ultrasonography-guided reduction 3,4,7) have been reported since the first successful case of reduction through the vagina reported by Funato et al in 1990 8) . As far as we know, there has been no report in Japan of intestinal damage after noninvasive reduction.…”

Section: Discussionmentioning

confidence: 99%

“…However, there was a report of thigh bleeding occurring after manual reduction 9) , and criteria for safe noninvasive reduction should therefore be established. Various criteria have been proposed, including maximum time from onset of 24 hours 3) , maximum diameter of 3cm for the incarcerated intestine 10) , maintenance of the contrast effect of the incarcerated intestine and no accumulation of fluid in the hernia sac, but a consensus regarding the criteria for performing manual reduction has not been reached. In our study, there were only 4 cases in wich maximum diameter of the incarcerated intestine exceeded 3cm (cases 1, 10, 23 and 25) and maximum diameter of the incarcerated intestine was 3cm or less in 9 cases in group B.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, the usefulness of elective surgery after noninvasive manual reduction has been reported for cases of obturator hernia, but there is no consensus regarding indication of manual reduction [1][2][3][4] . In the past 10 years, we have performed elective surgery after reduction of the incarcerated organ in two cases of obturator hernia, and we obtained good postoperative results.…”

Section: Introductionmentioning

confidence: 99%

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The Possibility of Elective Surgery in Obturator Hernia

Takahashi

Omori

Yoshifuku

et al. 2014

JJCS

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Abstract[Purpose] The usefulness of elective surgery after noninvasive manual reduction has been reported for cases of obturator hernia, but there is no consensus regarding indication of manual reduction. Therefore, we examined obturator hernia cases that we experienced in our hospital and evaluated the indication of manual reduction. [Materials and Methods] Thirty-three patients who underwent emergent surgery in the period from January 2003 to May 2013 were divided into a non bowel resection group (group A) and bowel resection group (group B).[Results] The average CRP level in group A was significantly lower than that in group B. The duration of symptoms in group A was significantly shorter than that in group B. The ratio of cases in which the contrast effect of the strangulated intestine on enhanced CT was maintained was higher in group A than in group B.[Conclusion] Noninvasive manual reduction and elective surgery should be considered in the case in which the contrast effect of the strangulated intestine has been maintained within 24 hours after onset and in which CRP level is less than 1.0mg/dl. Key words: obturator hernia, manual reduction, elective surgery IntroductionObturator hernias are mostly found in elderly and Received: December 4, 2013/ Accepted: March 31, 2014 Correspondence to: Yusuke Takahashi Department of Digestive Surgery, Niigata City General Hospital, 463-7 Shumoku Chuo-ku, Niigata, Niigata 950-1197, Japan underweight women, and emergent surgery is often performed in a poor state due to strangulation of the intestine and aspiration pneumonia after vomiting. Recently, the usefulness of elective surgery after noninvasive manual reduction has been reported for cases of obturator hernia, but there is no consensus regarding indication of manual reduction [1][2][3][4] . In the past 10 years, we have performed elective surgery after reduction of the incarcerated organ in two cases of obturator hernia, and we obtained good postoperative results. These two cases are presented here. We also reviewed cases of obturator hernia cases in which emergent surgery was performed in our hospital and evaluated the usefulness of elective surgery for obturator hernia. Case1Patient: 88-year-old woman. Chief complaint: right thigh pain. Past history: Hypertension. Present illness: She visited our hospital with the chief complaint of right thigh pain. Findings: Height ; 138cm, body weight ; 35kg, BMI ; 18.6. Tenderness in the right groin. Positive for Howship-Romberg sign． CT findings: The small intestine was incarcerated in the right obturator foramen on plain CT, and it was released spontaneously on additional contrastenhanced CT (Fig. 1 ). Treatment plan: She had bilateral inguinal hernias and we selected elective surgery. Operation: We performed hernioplasty bilaterally by Kugelʼs method.Her postoperative course was uneventful and she was discharged on the day after the operation. Tenderness in the right groin. CT findings: The small intestine was incarcerated in the right obturator foramen and intestinal obstr...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Possibility of Elective Surgery in Obturator Hernia

Takahashi

Omori

Yoshifuku

et al. 2014

JJCS

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“…According to successful cases of manual reduction of strangulated obturator hernia, there are cases in which manual reduction only and in which transvaginal manual reduction [ 3 ]. However, non-invasive manual reduction only may cause complications such as thigh bleeding [ 4 ]. When the diagnosis of obturator hernia was confirmed by CT, it is considered that reduction of the hernia, while confirming it in real time by echo-guide will lead to successful reduction of strangulated obturator hernia.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided non-invasive retraction for strangulated obturator hernia allows elective radical surgery: analysis of 12 cases

et al. 2021

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Background Obturator hernia is a life-threatening condition, requiring emergency intervention due to strangulation, if non-invasive repair for strangulation cannot be complete. Change from emergency surgery to elective surgery using minimal non-invasive options can greatly contribute to perioperative safety and curability of the underlying disease. Case presentation 12 cases of strangulated obturator hernia from April 2013 to February 2020 with male:female patient ratio of 0:12. Reduction under ultrasound guidance was possible amongst 10 out of 12 cases. The average age was 85.3 years (74–97) and average BMI was 17.4 (15.0–20.1). Based on physical findings and CT examination, diagnosis of obturator hernia was made using echo guided non-invasive reduction. Prevention in the intestinal ischemia and perforation was observed in the treated cases. Upon request, elective radical surgery was performed in 7 of these patients after their condition improved and monitored other organs for any signs. Conclusion Attempt to improve the strangulation of obturator hernia under an echo-guided approach could enable elective and safe surgery and is believed to be a diagnostic treatment worth attempting.

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Obturator Hernia in a Patient Undergoing Hemodialysis

et al. 2024

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Obturator hernia is a rare condition that commonly affects frail older women. A 54-year-old woman presented to our hospital with left hip joint pain. She had suffered a left pubic bone fracture and commenced maintenance hemodialysis. Pelvic computed tomography (CT) showed an incarcerated small intestine through the left obturator foramen, while abdominal CT showed marked intestinal dilatation. She underwent emergency laparotomy, and the incarcerated small intestine was found to be necrotic. Partial small intestinal resection and bilateral obturator hernioplasty were performed. Because obturator hernia is a potentially fatal condition, early detection and treatment are important.

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Non-Invasive Manual Reduction for Incarcerated Obturator Hernia-Report of Five Cases-

Cited by 10 publications

References 8 publications

The Possibility of Elective Surgery in Obturator Hernia

The Possibility of Elective Surgery in Obturator Hernia

Ultrasound-guided non-invasive retraction for strangulated obturator hernia allows elective radical surgery: analysis of 12 cases

Obturator Hernia in a Patient Undergoing Hemodialysis

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